Original Articles: Asthma, Lower Airway Diseases
Multicenter study of cigarette smoking among patients presenting to the emergency department with acute asthma

https://doi.org/10.1016/S1081-1206(10)60164-0Get rights and content

Background

Many studies have focused on smoking and chronic asthma severity. However, research on the relationship between smoking and acute asthma severity in an acute care setting is sparse.

Objectives

To determine the smoking prevalence among emergency department (ED) patients with acute asthma and to investigate the relationships between smoking and acute asthma severity.

Methods

A 63-site medical record review study of ED patients, ages 14 to 54 years, with a principal diagnosis of acute asthma was performed. Patients with chronic obstructive pulmonary disease were excluded. Measurements for acute asthma severity included sociodemographic factors, asthma medical history, ED presentation, clinical course, medications administered, and return visit within 48 hours.

Results

A total of 4,052 patient medical records were reviewed. A total of 1,332 patients (33%; 95% confidence interval, 31%–34%) were documented as smokers. No statistically significant differences were found between smokers and nonsmokers in vital signs, oxygen saturation, peak expiratory flow, and administration of asthma medications. By contrast, smokers were more likely than nonsmokers to receive antibiotics in the ED (12% vs 9%, P < .001) or at discharge (23% vs 14%, P < .001). A multivariate analysis confirmed that smoking status was independently associated with antibiotic administration (odds ratio, 1.6; 95% confidence interval, 1.3–1.8).

Conclusions

One-third of ED patients with acute asthma smoked cigarettes. Smokers and nonsmokers did not differ in their acute asthma severity. Asthmatic smokers, however, were more likely to receive antibiotics, even when adjusting for other possible confounders.

Section snippets

INTRODUCTION

Cigarette smoking has profound deleterious effects on the respiratory system. It initiates microscopic changes at a cellular level with the apoptosis of alveolar cells and endothelial cell malfunction,1, 2 creating an environment that leads to macroscopic structural and functional destruction. Over time, these cumulative insults cause a progressive deterioration in pulmonary function.3, 4, 5, 6

The deterioration of pulmonary function is worse in patients with asthma who smoke. Longitudinal

METHODS

The National Emergency Department Safety Study was a patient safety study based in US EDs. Details of the study’s methods have been published previously.13 Our analysis used data from the study’s asthma medical record review component.

A total of 63 EDs participated, with most sites (n = 48) being academic EDs (ie, affiliated with an emergency medicine residency program). Patients were included in this study if they were between the ages of 14 and 54 years and had a principal ED or hospital

RESULTS

A total of 4,052 medical records of patients with acute asthma were reviewed, and 33% (95% CI, 31%–34%) were found to smoke cigarettes. The median age of the smokers was 34 years (IQR, 24–43 years); 64% were women, and 47% were black. Compared with nonsmokers, smokers were more likely to be older and male (Table 1). No statistically significant differences were found in race/ethnicity and medical history pertaining to asthma between both groups.

Nonsmokers were more likely to be prescribed

DISCUSSION

The prevalence of smoking among asthmatic patients who present to EDs in our sample was 33% (95% CI, 31%–34%), which is similar to the prevalence of 35% found by Silverman et al11 in 1996 to 1998. Although there has been a steady decrease in the rate of smoking in the US adult population during the past 10 years to 21%,19 there seems to be no change in prevalence of smoking among individuals with asthma who present to EDs. This persistently high prevalence of smoking among patients with asthma

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    Disclosures: Dr Camargo has received financial support from a variety of groups for participation in conferences, consulting, and medical research. Recent industry sponsors with an interest in asthma were AstraZeneca, Critical Therapeutics, Dey, GSK, Merck, Novartis, Respironics, and Schering-Plough. The other authors have no declared conflicts of interest.

    Funding Sources: The National Emergency Department Safety Study was supported by grant R01 HS-13099 from the Agency for Healthcare Research and Quality (Rockville, Maryland).

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